Provider Demographics
NPI:1720134992
Name:LAKE, HEIKE A B (MED, LSW)
Entity Type:Individual
Prefix:MISS
First Name:HEIKE
Middle Name:A B
Last Name:LAKE
Suffix:
Gender:F
Credentials:MED, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 W HIGHWATER DR
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-9492
Mailing Address - Country:US
Mailing Address - Phone:208-691-3787
Mailing Address - Fax:
Practice Address - Street 1:210 W SPRAGUE AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-3627
Practice Address - Country:US
Practice Address - Phone:509-747-8224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00043068101Y00000X
IDLSW-1799104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker